Bottom Line:
Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001).Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001).Those results were found to be statistically significant (P < 0.001).

Background: Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.

Objectives: We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.

Patients and methods: This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.

Results: Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).

Conclusions: CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.

Mentions:
The study is based on the retrospective analysis of 682 cases out of consecutive 892 patients with acute cholecystitis admitted to 2 different centers: Sisli Etfal Training and Research Hospital, and Arnavutkoy State Hospital, General Surgery Clinics, in Istanbul, Turkey. Patients admitted to the hospital diagnosed with acute cholecystitis were identified retrospectively by using the International Classification of Disease, 10th revision (ICD-10) codes between January 2011 and July 2014. A total of 210 patients with other diseases causing high CRP levels were excluded from the study as follows: 4 patients with connective tissue diseases, 14 patients with respiratory tract or pulmonary infections, 11 patients with genitourinary tract infections, 4 patients with inflammatory bowel disease, 4 patients with soft tissue infections, 3 patients recently underwent any surgical procedure, 2 patients with history of recent burns or trauma, 20 patients with chronic liver disease, 33 patients with malignancy, 108 patients accompanying pancreatitis or cholangitis, and 7 patients younger than 18 years (Figure 1).

Mentions:
The study is based on the retrospective analysis of 682 cases out of consecutive 892 patients with acute cholecystitis admitted to 2 different centers: Sisli Etfal Training and Research Hospital, and Arnavutkoy State Hospital, General Surgery Clinics, in Istanbul, Turkey. Patients admitted to the hospital diagnosed with acute cholecystitis were identified retrospectively by using the International Classification of Disease, 10th revision (ICD-10) codes between January 2011 and July 2014. A total of 210 patients with other diseases causing high CRP levels were excluded from the study as follows: 4 patients with connective tissue diseases, 14 patients with respiratory tract or pulmonary infections, 11 patients with genitourinary tract infections, 4 patients with inflammatory bowel disease, 4 patients with soft tissue infections, 3 patients recently underwent any surgical procedure, 2 patients with history of recent burns or trauma, 20 patients with chronic liver disease, 33 patients with malignancy, 108 patients accompanying pancreatitis or cholangitis, and 7 patients younger than 18 years (Figure 1).

Bottom Line:
Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001).Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001).Those results were found to be statistically significant (P < 0.001).

Background: Acute cholecystitis is the most common complication of gallbladder stones. Today, Tokyo guidelines criteria are recommended for diagnosis, grading, and management of acute cholecystitis.

Objectives: We aimed to evaluate the levels of C-reactive protein (CRP) at different cut-off values to predict the severity of the disease and its possible role in grading the disease with regard to the guideline.

Patients and methods: This is a retrospective study, analyzing 682 cases out of consecutive 892 patients with acute cholecystitis admitted to two different general surgery clinics in Istanbul, Turkey. Records of patients diagnosed with acute cholecystitis were screened retrospectively from the hospital computer database between January 2011 and July 2014. A total of 210 patients with concomitant diseases causing high CRP levels were excluded from the study. The criteria of Tokyo guidelines were used in grading the severity of acute cholecystitis, and patients were divided into 3 groups. CRP values at the time of admission were analyzed and compared among the groups.

Results: Mean CRP levels of groups were found to be significantly different, 18.96 mg/L in Group I, 133.51 mg/L in Group II, and 237.23 mg/L in Group III (P < 0.001). Having examined CRP values among the groups, they were found to be highly and significantly correlated with the disease grade (P < 0.0001). After evaluating CRP levels according to the grade of the disease, group 2 was distinguished from group 1 with a cut-off CRP level of 70.65 mg/L, and from group 3 with a value of 198.95 mg/L. Those results were found to be statistically significant (P < 0.001).

Conclusions: CRP, a well-known acute phase reactant that increases rapidly in various inflammatory processes, can be accepted as a strong predictor in classifying different grades of the disease, and treatment can be reliably planned according to this classification.